How to match services and people's needs;

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The Crisis in Human Services
HOW TO MATCH SERVICES AND PEOPLE'S NEEDS
By JAMES C. SELMAN/Partner, Washington, D.C.
What is more dehumanizing than to run the "maze" of a
large complex organization—whether governmental or
private sector—seeking the solution to a problem?
Usually, if you are persistent, have a clear understanding
of your objectives, and use a f i rm voice, you can event­ually
accomplish your purpose. But frequently it is not
achieved without the frustration of being shunted from
person to person and department to department.
This article will present a plan which will help govern­mental
agencies integrate their response to the human
services needs of the people. A problem has arisen as
agencies set up over the years to meet one aspect of a
citizen's problem have not responded to his overall situa­tion.
The condition is known to public administrators as
"fragmentation," or lack of agency/program integration.
Fragmentation is a common problem facing the gov­ernmental
functions—environment, education, legis­lation,
transportation, and justice. It is especially true of
the agencies providing "human services." The human
services function is the largest function in all govern­ment
(federal, state, and local) in terms of numbers of
programs, dollars expended, and (with the possible ex­ception
of education) persons receiving direct services.
In most jurisdictions, "human services" usually in­cludes
welfare, children's services, vocational rehabili­tation,
health, mental health, corrections, unemploy­ment
insurance, manpower development, and a variety
of related special programs—such as those for the aged
or special planning functions. Although their orga­nizational
mix varies from jurisdiction to jurisdiction,
these programs collectively comprise between one-half
to two-thirds of most local government budgets. But the
overlapping scope of the programs often poses, in turn,
an overwhelming problem for the 35 to 40 million
persons who receive some assistance each year from one
or more human services agencies.
Imagine, for example, the plight of a disabled mother
on welfare. She has a husband in a correctional facility, a
brother who is unemployed and may be eligible for
insurance benefits, a son having problems in school,
another child who has dropped out of school and is using
drugs—all this plus a health problem of her own. More­over,
this disabled mother has neither an automobile nor
a telephone, and she possesses minimal formal educa­tion,
lacks vocational skills, and is not very good at ex­pressing
herself verbally. What is she going to do?
The chances are she enters the maze of governmental
agencies following the suggestion of a friend or a welfare
caseworker, or simply out of desperation. Her first call
will probably be on the agency which can best help her
with her major problem. Since she has many different
problems, however, she will, no doubt, be sent to other
agencies as well. At each one she will probably fill out an
application and "tell her story" to the sympathetic service
professionals. Frequently she will learn that she has been
talking to the wrong person, and will probably be
referred to another public or private agency. Then, once
she is accepted by several agencies, she may discover that
the service workers do not agree on what she should do.
One worker may be trying to get a problem child into
school, another may be recommending vocational
training, and a third suggesting a concentrated drug
outpatient program. Unfortunately, this unlearned
woman must reconcile the opinions of all these individ­uals
and make an overall assessment of her family's
situation.
Fragmentation results when legislation is passed to
meet a new or growing social problem for an identifi­able
segment of the population—such as the mentally
retarded, the blind, the impoverished, the criminal, the
unemployed, the disabled, the aged, children, or a
variety of minority groups. As long as these services do
not significantly overlap, there is no particular problem
with this approach. However, when they do overlap,
words like "program," "organization," "service delivery
system," and "client type" become almost synonymous.
In other words, despite our best intentions, our human
resources program becomes almost completely
fragmented.
Why aren't we really integrated?
Those administering a program are frequently criticized
for not listening to client perceptions. Yet the challenge
inherent in integrating literally hundreds of programs
into a single delivery system is extremely complex,
especially in large urban centers.
What are some of the major pitfalls to avoid in
attempting to integrate services? They are:
A wrong perspective—Human services workers have a
sincere interest in "helping" clients, but often they see
the client's needs only in terms of his eligibility for their
organization's mission. Their perspective must begin with
the client, not with their own program.
Too many layers of administration—When the goals of
an umbrella agency are based on the activities of all its
divisions, the umbrella often becomes just another
administrative layer. With the staff so involved in day-to­day
management matters, a broader client service per­spective
is lost. As a result, there is very little change in
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